RU2679513C1 - Method for predicting the likelihood of a complicated course of pregnancy in the second trimester of pregnancy - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention relates to medicine, namely to obstetrics and gynecology, and can be used to predict the likelihood of a complicated course of pregnancy in the second trimester. Conduct psychological testing using informative scales of the method “Quality of life SF-36” and factors according to the test questionnaire “Big five”. They evaluate the quality of life according to the parameters “mental health”, “intensity of pain”, “emotional instability – emotional stability”, “attachment – isolation”, “satisfaction with the ecology of the urban environment”. According to the presence or absence of data weight signs assign a numerical value of the coefficient. Calculate the discriminant function f according to the formula:, where Aj is the total value of the quantitative weight attribute in points; Xj is the numerical value of the regression coefficient of the quantitative weight attribute; Bj is the numerical value of the regression coefficient of the qualitative weight attribute X1 – “mental health”; 0.111 is the numeric value of the regression coefficient of this feature; X2 – “intensity of pain”; -0.014 is the numerical value of the regression coefficient of this feature; X3 – “emotional instability – emotional stability” 0.287 – the numerical value of the regression coefficient of this feature; X4 – “attachment – isolation”; -0.309 – the numeric value of the regression coefficient of this feature. B1 – assessment of the ecology of the urban environment, 24.339 is the numerical value of the regression coefficient of this attribute for the assessment of the ecological environment “excellent”; -5.052 “very good”; -4.568 “good”, -5.605 “mediocre”. Determine the value of the probability of attributing an individual to a group with a high or a group with a low probability of developing a complicated course of pregnancy P according to the formula: P = 1-e/(1+e) where e is a mathematical constant equal to 2.72. With a P value close to 0, a low is determined, and with a P close to 1, a high probability of developing a complicated course of pregnancy.EFFECT: method provides an increase in the accuracy and informativeness of prediction by identifying additional factors affecting the course of the gestational process, childbirth and the condition of the newborn, and also allows the formation of a group of increased obstetric and perinatal risk.1 cl, 6 tbl, 1 ex

Description

The invention relates to medicine, namely to obstetrics and gynecology, and is intended to predict the likelihood of a complicated pregnancy in the second trimester of pregnancy.

Establishing the most important factors and conditions for the normal physiological course of pregnancy, childbirth and the condition of the newborn and their relationship allows us to predict the course of pregnancy and develop additional criteria for the formation of groups of increased obstetric and perinatal risk [1, 7, 28, 29, 30, 31]. It is known that many factors influence the physiological course of pregnancy. The main ones are the psychological state of a woman during pregnancy, the conditions in which she is located, relationships in the family, team, social status, and also the quality of the conditions of the urban environment. Most of the studies in this area are devoted to the study of the influence of the psychoemotional and individual-characterological characteristics of women and their connection with the complicated course of the gestational process. However, the physiological course of pregnancy is not limited to the influence of only psychoemotional factors [2, 3, 8, 20, 26, 29, 30]. There are three groups of factors affecting the normal course of pregnancy: internal (psycho-emotional state), meso-factors (woman's quality of life) and macro-factors (quality of the urban environment). These factors also affect the course of labor and the condition of the newborn. Quality of life is understood as an assessment of the conditions and characteristics of a woman’s life and the degree of satisfaction with these conditions. Under the quality of the urban environment is meant an assessment by women of the ability of the urban environment to satisfy their needs and requirements.

The continuing interest in this issue and the disappointing demographic indicators indicate that the contribution of medical factors during the gestational process and the condition of the newborn are often not decisive, which necessitates a more detailed study of risk factors for the complicated course of pregnancy and childbirth in related areas. Thus, the assessment of the influence of the psychoemotional state, quality of life and the urban environment on the physiological course of pregnancy, childbirth in a woman and the condition of the newborn is an important component in predicting the complicated course of pregnancy and establishing additional risk factors and their relationship [5, 10, 16, 18] .

In the case when, for a number of reasons, a pregnant woman does not register for pregnancy at the beginning of pregnancy, but in the second trimester, the task of the doctor conducting such a pregnancy is complicated, since by this time the uteroplacental complex has been practically formed and the opportunities for early prevention have been missed, therefore Patients need close attention for timely diagnosis and treatment of possible complications.

An integrated approach to predicting the complicated course of pregnancy is used by many authors [6, 9, 11, 12, 13, 15, 17, 19, 21, 23, 25, 32]. So, the analysis of various risk factors was used in the works of A.A. Suverneva et al. [24]. However, this method was used only during childbirth, and not during pregnancy, and did not cover the psychological aspects and social factors, and mainly concerned the outcome of childbirth and the viability of the newborn. In order to expand the arsenal of tools for predicting the course of pregnancy, a prediction method has been proposed that estimates the index of tension of regulatory systems [22]; from 20 weeks, prediction of preterm birth is possible taking into account the clinical and laboratory parameters of the pregnant woman [4]; Monitoring scales for pregnant women at risk make it possible to predict the course of pregnancy and childbirth [27].

Closest to the proposed is the "Method for predicting preterm birth in patients with primary habitual miscarriage" [4]. When registering in a antenatal clinic, a somatic and obstetric-gynecological history is collected. Groups of women with habitual miscarriage on the basis of reproductive debut are distinguished. A complex of studies is being conducted aimed at identifying a history of missed pregnancy syndrome, signs of connective tissue dysplasia in mothers, the presence of placental insufficiency, the presence of intrauterine growth retardation, severe preeclampsia, and chronic intrauterine infection sanitized during pregnancy. Based on the analysis of the information received, the presence or absence of the threat of premature birth is predicted. The invention allows to predict preterm delivery in patients with primary habitual miscarriage at the outpatient stage starting from 20 weeks of gestation and, therefore, to prevent early delivery in a timely manner, thereby reducing perinatal morbidity and mortality.

However, this method does not include an assessment of the psychological state of the pregnant woman and her macroenvironment, which plays an important role in developing a prognosis of pregnancy and the condition of the newborn.

A new technical result is an increase in the accuracy and information content of the method.

To achieve a new technical result in a method for predicting the likelihood of a complicated pregnancy in the second trimester of pregnancy, by examining the patient, in the second trimester, psychological testing is carried out using informative scales of the SF-36 Quality of Life methodology and factors according to the Big flve test questionnaire, including an assessment of the quality of life according to the parameters “mental health”, “intensity of pain”, “emotional instability - emotional stability”, “attachment - isolation”, “ dovletvorennost environment urban environment ", the presence or absence of data attributes are assigned numeric weight coefficient is calculated discriminant function f by the formula:

Where

Aj is the total value of the quantitative weight attribute in points;

Xj is the numerical value of the regression coefficient of a quantitative weight attribute;

Bj is the numerical value of the regression coefficient of a qualitative weight attribute

X1 - “mental health”;

0,111 - the numerical value of the regression coefficient of this sign;

X2 - "pain intensity";

-0.014 - the numerical value of the regression coefficient of this sign;

X3 - "emotional instability - emotional stability"

0.287 is the numerical value of the regression coefficient of this sign;

X4 - "attachment - isolation";

-0.309 - the numerical value of the regression coefficient of this sign.

B1 - assessment of the ecology of the urban environment,

24.339 the numerical value of the regression coefficient of this attribute for assessing the ecological environment is “excellent”; -5,052 "very good"; -4,568 “good”, -5,605 “mediocre”

further, the probability value of assigning an individual to a group with a high or a group with a low probability of developing a complicated pregnancy P is determined by the formula:

P = 1-e ^f / (1 + e ^f ),

where e is the mathematical constant equal to 2.72

and when the value of P is close to 0, determine a low and when P is close to 1, a high probability of developing a complicated pregnancy.

The method is as follows.

When a pregnant woman is registered, a standard medical examination is carried out according to order 572n of the Ministry of Health of the Russian Federation dated 01.11.2012. The results are entered into the table of the scale for assessing risk factors for perinatal pathology (V.E. Radzinsky, S.A. Knyazev, I.N. Kostin, Table 1). If a woman’s indicators correspond to a low degree of risk (less than 15 points), her examination is supplemented by the “Quality of Life SF-36” rating scale, the five-factor personality questionnaire (“Big five”) by R. McCray and P. Costa, the urban environmental satisfaction scale Wednesday.

The parameters “mental health”, “intensity of pain”, “emotional instability - emotional stability”, “attachment - isolation” “mental health”, “intensity of pain”, “emotional instability - emotional stability”, “attachment - isolation” are calculated in points according to relevant questionnaires.

The presence or absence of qualitative signs “Satisfaction with the ecology of the urban environment” is assigned the numerical value of the regression coefficient (table 5). calculate the discriminant function f according to the formula:

Where

Aj is the total value of the quantitative weight attribute in points;

Xj is the numerical value of the regression coefficient of a quantitative weight attribute;

Bj is the numerical value of the regression coefficient of a qualitative weight attribute

X1 - “mental health”;

0,111 - the numerical value of the regression coefficient of this sign;

X2 - "pain intensity";

-0.014 - the numerical value of the regression coefficient of this sign;

X3 - "emotional instability - emotional stability"

0.287 is the numerical value of the regression coefficient of this sign;

X4 - "attachment - isolation";

-0.309 - the numerical value of the regression coefficient of this sign.

B1 - assessment of the ecology of the urban environment,

24.339 the numerical value of the regression coefficient of this attribute for assessing the ecological environment is “excellent”; -5,052 "very good"; -4,568 “good”, -5,605 “mediocre;”

further, the probability value of assigning an individual to a group with a high or a group with a low probability of developing a complicated pregnancy P is determined by the formula:

P = 1-e ^f / (1 + e ^f ),

where e is the mathematical constant equal to 2.72

and when the value of P is close to 0, determine a low and when P is close to 1, a high probability of developing a complicated pregnancy.

The patient's belonging to the group with a high probability of developing pregnancy complications allows her to be attributed to the group of increased obstetric and perinatal risk.

The proposed criteria for the diagnostic method were determined based on the analysis of clinical research data.

The study involved pregnant women (n = 102), who were registered with the antenatal clinic at a gestational age of 12-14 weeks. When registering a pregnant woman, a standard medical examination was carried out according to order 572n of the Ministry of Health of the Russian Federation dated 01.11.2012. The results were entered in the table of the scale for assessing risk factors for perinatal pathology (V.E. Radzinsky, S.A. Knyazev, I.N. Kostin) according to which the patients were divided into risk groups: up to 15 points - low, 15-24 points - medium, more than 25 points - high.

The criteria for inclusion in the study were gestational age 12-14 weeks, a low degree of obstetric and perinatal risk, informed consent to participate in the study.

All pregnant women were offered a set of psychological research methods and a scale of satisfaction with environmental conditions.

The quality of life of women was studied using the “Quality of Life” SF-36 methodology. This technique is adapted by the Institute of Clinical and Pharmacological Research (St. Petersburg) includes 36 points, which are grouped into eight scales:

 “Physical functioning” (PF), “Role-based functioning due to physical condition” (RPP), “Intensity of pain” (BP), “General state of health” (GH), “Vital activity” (VT), “Social functioning” ( SF), “Role-based functioning due to emotional state” (RE) and “Mental health” (MN). The performance of each scale varies between 0 and 100. Two components are distinguished within the methodology, the first is the physical health component, it includes scales: “Physical functioning”, “Role-based functioning due to physical condition”, “Pain intensity” and “General health status” ". The second component is the psychological component of health, it consists of scales: “Mental health”, “Role-based functioning due to emotional state”, “Social functioning” and “Life activity”. The results are presented in the form of scores on 8 scales, designed in such a way that a higher score indicates a higher level of quality of life. A score of less than 30 corresponds to a low level of the parameter being studied, from 30 to 60 to an average, above 60 points to a high.

The five-factor test questionnaire is a set of 75 paired, opposite in value, stimulus statements characterizing human behavior. Stimulus material has a five-step Likert rating scale (-2; -1; 0; 1; 2), with which you can measure the severity of each of the five factors (extraversion - introversion; attachment - isolation; self-control - impulsivity; emotional instability - emotional stability ; expressivity - practicality). The questionnaire has no statements of right or wrong, as well as no good or bad personality traits. The severity of each of the 75 paired statements is determined using the above rating scale. The minimum number of points scored for any major factor is 15, the maximum number is 75. Conditionally, scores can be divided into high (51-75 points), medium (41-50 points) and low (15-40 points).

Macro-factors (quality of the urban environment) of the environment were studied using the author's questionnaire to study the degree of satisfaction of the urban environment (table 2). The assessment was carried out in points from 1 to 5, which show the degree of satisfaction with the infrastructure and the ecological condition of the district.

During the second trimester of pregnancy, all pregnant women received a set of diagnostic and treatment measures corresponding to their somatic and obstetric status.

At the end of the second trimester, all pregnant women were reassessed of obstetric and perinatal risk factors, according to which they were divided into 2 groups. The first (n = 55) were pregnant women, corresponding to a low degree of risk on the scale of perinatal pathology (11 ± 2.21 points). The second group (n = 48) consisted of medium-risk patients (17 ± 1.23 points).

Given that at the time of registration for pregnancy all women had a low degree of risk, the aim of the study was to identify statistically significant differences between groups, which can be used as prognostic criteria for complications of the gestational process.

The data obtained were subjected to statistical processing. The arithmetic mean, quadratic deviation, standard error of the arithmetic mean for quantitative indicators were calculated. When processing the data, the following statistical methods were used: Student's T-test, chi-square method, analysis of variance and discrimination, and correlation analysis. Statistical data processing was performed on a personal computer using the package of standard international application programs Statistica for Windows (V. 6.0). When constructing decision rules, we used logistic regression, a multidimensional statistical method that allows us to build models for predicting the course of pregnancy based on a set of quantitative and qualitative features.

The demographic indicators of the study sample were as follows: age 19-25 years - 32%, 26-33 years old - 49%, 34-43 years old - 19% of pregnant women. Registered marriage took place in 51% of cases, civil marriage - in 49% of cases. Most pregnant women had higher education (52%), the rest had secondary special and secondary education (27% and 21%, respectively). There were no statistically significant differences between the compared groups according to these indicators. There were no significant differences in obstetric status.

At the next stage of the study, using the descriptive statistics of the indicators of the scales of the Five-Factor Test-Questionnaire (Big five) R. McCrae and P. Costa and the Semantic Differential C. Osgood, personality characteristics and features of the attitude of women to themselves, to their pregnancy, and to an intrauterine developing child and to the future (Table 3). According to the table, it can be seen that almost all indicators of the personality test questionnaire have average values. Most of the women in this group are sociable, tend to have a large circle of acquaintances, while being restrained, self-confident, have an even mood background, are guided by internal supports in their actions. They tend to feel the need to form close emotional contacts, while they are quite independent and tend to give priority to their own needs and interests. Most of the women in this sample are responsible, accurate, obligatory while being prone to rash actions and impulsive. It was revealed that women with the threat of abortion are more inclined to follow the established rules when performing any activity. Unlike women with a normal physiological course of pregnancy, they are extremely executive, responsible, strict and accurate, for them it is very important to strive for the ideal quality of work that they are ready to spend a lot of their own resources on. Significant differences were identified by the parameters “Emotional instability - Emotional stability” and “Attachment-Separation”.

According to Table 4, it is seen that the quality of life of women in the second trimester of pregnancy is determined by high rates on the scales: “Physical functioning” (PF), “Intensity of pain” (BP), “General health status” (GH), “Social functioning” ( SF), “Role-based functioning due to emotional state” (RE) and “Mental health” (MN). The average values were obtained on the scales: “Role-based functioning due to physical condition” (RPP) and “Vital activity” (VT).

Based on the statistical processing of the results of an additional study, factors were identified that have statistically significant differences in the compared groups of low and medium obstetric and perinatal risk.

To construct the decision rules, the most frequently recorded signs were chosen as independent variables:

- Average level of mental health indicators

- High pain intensity

- Emotional instability

- Emotional resilience

- Affection - Separation

- All parameters of satisfaction with the ecology of the urban environment and the infrastructure of the district

calculate the discriminant function f according to the formula:

Where

Aj is the total value of the quantitative weight attribute in points;

Xj is the numerical value of the regression coefficient of a quantitative weight attribute;

Bj is the numerical value of the regression coefficient of a qualitative weight attribute

Xi - “mental health”;

0,111 - the numerical value of the regression coefficient of this sign;

X2 - "pain intensity";

-0.014 - the numerical value of the regression coefficient of this sign;

X3 - "emotional instability - emotional stability"

0.287 is the numerical value of the regression coefficient of this sign;

X4 - "attachment - isolation";

-0.309 - the numerical value of the regression coefficient of this sign.

B1 - assessment of the ecology of the urban environment,

24.339 the numerical value of the regression coefficient of this attribute for assessing the ecological environment is “excellent”; -5,052 "very good"; -4,568 “good”, -5,605 “mediocre;”

further, the probability value of assigning an individual to a group with a high or a group with a low probability of developing a complicated pregnancy P is determined by the formula:

P = 1-e ^f / (1 + e ^f ),

where e is the mathematical constant equal to 2.72

and when the value of P is close to 0, determine a low and when P is close to 1, a high probability of developing a complicated pregnancy.

The sensitivity and specificity of this model and the percentage of its correct recognition were calculated. Its sensitivity was 71.4%, specificity -82.8%, the percentage of correct recognition - 78.0% (table 5, 6).

Thus, the developed method allows with a high degree of probability to determine the medical and psychological prognostic factors of the violation of the physiological course of pregnancy. Pregnant women who feel painful conditions, are prone to rapid mood swings, prefer privacy to close relationships and are not satisfied with the quality of the urban environment during the second trimester of pregnancy are likely to have complications.

Example 1. Patient A., 25 years old. Appealed to the obstetrician-gynecologist for registration on pregnancy. Real pregnancy 2nd, history of 1 urgent delivery without complications. When registering, it was examined in accordance with Order No. 572 of the MZRF. According to the scale of assessment of perinatal risk factors, it corresponded to a low degree (work associated with emotional stress - 1 point, the presence of early toxicosis of mild severity 2 points). Diagnosis at the time of registration: Pregnancy 12 weeks. Early toxicosis of mild severity.

For further examination, the woman was offered a complex

psychological techniques and a scale for assessing satisfaction with the environment. The results of the study showed an average indicator of mental health (42 points), high pain intensity (84 points), isolation (54 points), emotional instability (62 points), low satisfaction with the urban environment (5 points for each parameter).

The value of the discriminant function f was calculated by the formula:

f = (0.111 * 42-0.014 * 84 + 0.287 * 62-0.309 * 52) -5.605 = -1.011

Further, the probability value of the complicated course of pregnancy was determined by the formula:

P = 1-e ^f / (1 + e ^f ) = 1-2.72 ^ (- 1.011) / (1 + 2.72 ^ (- 1.011)) = 0.73.

The probability of a complicated pregnancy was 0.73, which made it possible to attribute it to the increased risk group for the formation of gestational complications. Further support of the woman during pregnancy was carried out together with a psychologist according to an individually developed program, taking into account the identified changes. The third trimester of pregnancy, childbirth and the postpartum period were uneventful. A female child was born at 39-40 weeks. Height 53 cm., Weight 3450, with a rating on the APGAR scale of 9-9 points. Follow-up tracking allowed us to fix the stability of the emotional state and the satisfactory condition of the woman and the child.

Thus, the proposed method for predicting the complicated course of pregnancy with the help of identified additional factors that affect the course of the gestational process, childbirth and the condition of the newborn and their relationship, allows us to predict the course of pregnancy, taking into account additionally identified criteria for the formation of groups of increased obstetric and perinatal risk. The results also indicate the need for early identification of risk factors for the development of pregnancy pathology. It is substantiated that the early detection of prognostic factors of an unfavorable course of pregnancy will allow the development of targeted programs for medical and psychological support of the process of gestation. The implementation of these programs will help prevent the development of pregnancy pathology, solve an important demographic problem, and reduce economic costs at the stage of clinical treatment.

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APPENDICES

Table 1. Scale for assessing risk factors for perinatal pathology (V.E. Radzinsky, S.A. Knyazev, I.N. Kostin).

Table 2. The quality of the urban environment

Table 3. Five-factor personality questionnaire (Big five) R. McCrae and P. Costa

Table 4. Self-assessment of mental conditions.

Table 5. The structure of the mathematical model for predicting the course of pregnancy for the first trimester of pregnancy.

Table 6. Quality classification

* - significance of differences between groups 1 and 2.

* - significance of differences between groups 1 and 2.

Claims (20)

A method for predicting the likelihood of a complicated pregnancy in the second trimester of pregnancy, by examining the patient, characterized in that in the second trimester psychological testing is carried out using informative scales of the SF-36 Quality of Life technique and factors from the Big Five questionnaire, including an assessment quality of life according to the parameters “mental health”, “intensity of pain”, “emotional instability - emotional stability”, “attachment - isolation”, “satisfaction with the environment urban environment ", the presence or absence of these weight characteristics is assigned a numerical value of the coefficient, the discriminant function f is calculated by the formula:

Where Aj is the total value of the quantitative weight attribute in points; Xj is the numerical value of the regression coefficient of a quantitative weight attribute; Bj is the numerical value of the regression coefficient of a qualitative weight attribute; X1 - “mental health”; 0,111 - the numerical value of the regression coefficient of this sign; X2 - "pain intensity"; -0.014 - the numerical value of the regression coefficient of this sign; X3 - "emotional instability - emotional stability" 0.287 is the numerical value of the regression coefficient of this sign; X4 - "attachment - isolation"; -0.309 - the numerical value of the regression coefficient of this sign; B1 - assessment of the ecology of the urban environment; 24.339 the numerical value of the regression coefficient of this attribute for assessing the ecological environment is “excellent”; -5,052 "very good"; -4,568 “good”, -5,605 “mediocre”; then determine the probability of assigning an individual to a group with a high or a group with a low probability of developing a complicated pregnancy P by the formula

where e is the mathematical constant equal to 2.72, and with a value of P close to 0, a low is determined, and with a P close to 1, a high probability of developing a complicated pregnancy is determined.